As you should understand, the Centers for Medicare & Medicaid Services (CMS) is planning additional cuts to Medicare reimbursement for cancer care. In addition to a scheduled cut of 21.5% to all physician-related services, CMS is planning to cut payments to oncology by a net 6%. In brief, these cuts are based on a survey conducted by the American Medical Association (AMA), which the Community Oncology Alliance (COA) told the AMA was flawed for community oncology.

On the COA website at www.communityoncology.org under the Immediate Action Needed section is a tool that will allow you to estimate the impact of changes proposed by CMS in the 2010 Medicare Physician Fee Schedule. We encourage you to use the tool to estimate the impact of the cuts on your practice. The leadership team of the COA Administrators’ Network used the tool and collectively found the following:

• Oncology-specific cuts related to infusion room services are estimated to be 20.6% in 2010.
• The total impact of the cuts is 6.4%, factoring in an increase in E&M payments and the elimination of the consultation codes.

Please note that these estimates assume that Congress will act in health care reform legislation to avert the 21.5% cut. If this does not happen, the total estimated impact of the Medicare cuts would be 26.5% for oncology practices. Run the estimates for your practice. If you have any questions about using the tool, please contact Ricky Newton .

Understanding the impact of these proposed cuts is important because COA is challenging them and will be providing instructions on how every community oncology practice should weigh in with CMS and their Members of Congress. We also encourage every practice to return the Components of Care Survey, which can also be accessed on the COA website. Armed with actual community oncology data is critical in supporting our ask. The time is now to send in your data if you want to reverse the cuts slated for oncology.

In addition to these reductions, there are planned cuts to diagnostic imaging and therapeutic radiation. We will provide more information on those.

The Community Oncology Alliance Responds to President Obama’s Press Conference Comments Regarding Cancer Patients

WASHINGTON, D.C. (July 23, 2009) – The Community Oncology Alliance (COA), a national non-profit organization of oncologists that advocates for cancer patients and community providers of cancer care, has responded in a public statement to President Obama’s press conference, saying:

“We strongly support President Obama’s guiding principle that health care reform must “build on what works and fix what is broken.” Unfortunately, that is the exact opposite of what is happening with our country’s cancer care delivery system. The problem is that the Medicare payment system for cancer care is simply broken. The system has chipped away for years and our cancer care delivery system is now in crisis. Though it urgently needs to be fixed, we pray that reform is not forced through to meet a schedule, but thought through to meet the needs of covering costs to save the lives of cancer patients.

“In last night’s press conference, President Obama mentioned the plight of cancer patients. As the doctors who treat 84% of cancer patients in their own communities, we feel compelled to respond with the hope that even greater focus will be put on cancer as 1 in 2 men and 1 in 3 women can expect to get cancer in their lifetimes.

“As of right now, 45% of all cancer patients are covered by Medicare and yet Medicare does not reimburse oncologists for the full cost of many drugs to treat patients, and does not reimburse at all for essential services including cancer treatment planning and care coordination. In a recent national survey we commissioned of over 1,000 Americans, we learned that less than half (45%) of Americans believe their health insurance plans would cover the full cost of cancer treatment, including diagnosis, doctor visits, tests and medication, and only 25% of Americans believe that a person covered under Medicare would be covered, while 64% believe Medicare would not cover the cost of treatment.

“Today most community oncologists around the country are paying out of pocket to treat their Medicare patients. Additionally, over the past few years, Medicare has consistently cut payments for cancer patients and this is slowly dismantling the country’s treatment system. Even now CMS is pursuing a course of action, based on insufficient and inaccurate data, which will further severely cut payments for cancer care. Physicians cannot continue to shoulder these losses.

“Additional cuts now planned by CMS are simply unrealistic: they will accelerate the erosion of the nation’s cancer care delivery system. In reforming our country’s healthcare system, if a “public” insurance option is created based on Medicare — or even 5-10% above Medicare rates — and results in private insurers lowering their payments accordingly, practices simply would have to close their doors. This is borne out by modeling work recently completed by several large practices.

“We call on President Obama, who used examples of cancer patients in his comments, to consider the incredible hurdles facing both today’s cancer patients and doctors in treating cancer.

“Dr. Robert Fein, a medical oncologist practicing in Somerset, New Jersey, stated it best an editorial he penned recently for the New Jersey Star-Ledger.

“As we reform health care, we must address the plight of cancer patients… Just as I would treat a sick patient, we must fix a broken system, starting with Medicare.”

“We have heard the President’s request to the medical community to help shoulder a portion of the price for health care reform. Community oncology practices have already contributed more than their share by enduring Medicare payment cuts in excess of 25% over the past 5-6 years.

“Despite these challenges, we are committed to being a part of the solution. Over this past year, COA convened a task force of practicing oncologists to analyze Best Practices for improving the quality of cancer care while controlling costs, which can also be implemented without major infrastructure changes.

“The result of that effort is embodied in legislation that was recently introduced in the Congress by Representatives Artur Davis, Steve Israel, and Mary Jo Kilroy — the Medicare Quality Cancer Care Demonstration Project Act of 2009 (H.R. 2872). This bill would create a national cancer care demonstration project, open to all oncology clinics, which would refine quality metrics dealing with recognized, evidence-based treatment guidelines and patient-centric, coordinated care. The demonstration project would include the active involvement of community cancer clinics already using electronic medical records, bringing information to augment data collected by the Medicare system. This is a real-life application of health information technology, and the type of public-private collaborative effort that will be necessary to reform the health care system.

“The United States has the best overall cancer care in the world as documented by five-year survival rates — a true measure of performance. The success is due in large part to earlier detection, more precisely targeted therapies, and unparalleled access to quality, compassionate cancer care. During the past 25 years, cancer care in this country has evolved away from long stays at hospitals for chemotherapy treatments, to the outpatient, community setting. Along with advances in medicine, it is this system that is hailed as one of the best, and the smartest, in the world.

“With all of our success, cancer is still the second leading cause of death in this country, claiming on average the life of one American every minute.

“COA pledges that cancer clinics across the country will work together to increase the quality of cancer care while controlling costs; however, we need President Obama’s leadership to help overcome the immediate crisis that is now destroying what has worked so well for our patients. Our ability to treat the current and future generations of Americans battling cancer hangs in the balance.”

More information can be found on the COA web site at www.communityoncology.org.

COA Letter to President Obama on Cancer Crisis

Copy of a letter sent by COA President Patrick Cobb, MD to President Obama

President Barack Obama
The White House
1600 Pennsylvania Avenue, NW
Washington, DC 20500

Dear Mr. President:

We strongly support your guiding principle that health care reform must “build on what works and fix what is broken.” Unfortunately, that is the exact opposite of what is happening with our country’s cancer care delivery system. Recently announced cuts to Medicare reimbursement for cancer care by the Centers for Medicare & Medicaid Services (CMS) will accelerate the cancer care crisis already created by a broken Medicare payment system. On behalf of the Community Oncology Alliance (COA), a non-profit organization representing the interests of community oncology practices, I am writing to ask you to work with us to urgently address this crisis as part of health care reform.

Although health care reform is critically needed, the United States has the best overall cancer care in the world as documented by five-year survival rates — a true measure of performance. The success is due in large part to earlier cancer detection, more precisely targeted therapies, and unparalleled access to quality, compassionate cancer care. During the past twenty-five years, cancer care has evolved to the outpatient, community setting, where now over 80% of Americans battling cancer are treated. Even with this success, we should strive to better enhance the quality of cancer care, while looking for ways of controlling increasing costs.

The problem is that the Medicare payment system for cancer care is simply broken. Dr. Robert Fein, a medical oncologist practicing in Somerset, New Jersey, stated it best in these excerpts from an editorial he penned recently for the (New Jersey) Star Ledger.

“The cancer care delivery system is broken. It has reached the point where medical practices cannot stay in business and patients often cannot afford necessary treatments.

Over the past 2 to 3 years, Medicare has consistently lowered reimbursement for chemotherapy drugs and administration to oncologists. Additionally, Medicare does not reimburse for essential services such as treatment planning and care coordination.

As further cuts occur, physicians cannot continue to shoulder losses... As we reform health care, we must address the plight of cancer patients… Just as I would treat a sick patient, we must fix a broken system, starting with Medicare.”

Under the watch of the previous Administration, CMS failed to deliver on the congressional intent of the Medicare Modernization Act of 2003 relating to cancer care funding. As a result, Medicare not only significantly underpays for the critical services involving the administration of life-saving cancer drugs, but does not reimburse for essential services such as treatment planning and care coordination. Now, CMS is pursuing a course of action, based on insufficient and inaccurate data, which will further severely cut payments for cancer care.

We hear your request to the medical community to help pay a portion of the price for health care reform. Community oncology practices have already contributed more than their share by shouldering Medicare payment cuts in excess of 25% over the past 5-6 years. Additional cuts, as now planned by CMS, are simply unrealistic — they will truly accelerate the dismantling of the nation’s cancer care delivery system. If a “public” insurance option is created based on Medicare — or even 5-10% above Medicare rates — and results in private insurers lowering their payments accordingly, practices simply would have to close their doors. This is borne out by modeling work recently completed by several large practices.

Despite these challenges, we are committed to being a part of the solution. Over eight months ago, COA convened a task force of practicing oncologists to analyze ways of improving the quality of cancer care while controlling costs. The result of that effort is embodied in legislation that was recently introduced in the Congress by Representatives Artur Davis, Steve Israel, and Mary Jo Kilroy — the Medicare Quality Cancer Care Demonstration Project Act of 2009 (H.R. 2872). This bill would create a national cancer care demonstration project, open to all oncology clinics, dealing with active treatment and end-of-life care — the latter something you highlighted during your recent White House forum on health care reform. This national project would refine quality metrics dealing with recognized, evidence-based treatment guidelines and patient-centric, coordinated care. Centered on quality and cost efficient medical care, this demonstration project can be implemented without major infrastructure changes. It is intended to result in a new payment mechanism that incentivizes quality cancer care delivery that controls cost. Additionally, COA will actively involve community cancer clinics already using electronic medical records to bring information that would augment data collected by the Medicare system. As such, this is not only a real-life application of health information technology, but also the type of public-private collaborative effort that will be necessary to truly reform the health care system.

Last week, over 100 oncologists, nurses, administrators, patients, caregivers, and survivors came to Capitol Hill to discuss the crisis in cancer care. Following this legislative day, the cancer community across the country will now be making a massive outreach to their members of Congress to further discuss the crisis, recent CMS planned cuts, and specific solutions such as embodied in the demonstration project summarized above.

With all of our success, cancer is still the second leading cause of death in this country, claiming on average the life of one American every minute. Additionally, the incidence of cancer is increasing, but we are losing oncologists relative to demand. By 2020 we will be short an oncologist for every one in three cancer patients.

We need to act immediately to fix the broken Medicare reimbursement system for cancer care — and not make it worse by implementing a new round of planned payment cuts. Furthermore, basing a “public” insurance option on a broken Medicare system for cancer care, without first fixing it, will be catastrophic. COA pledges that cancer clinics across the country will work together to increase the quality of cancer care while controlling costs; however, we need your leadership to help overcome the immediate crisis that is now dismantling what has worked so well for our patients. Our ability to treat the current and future generations of Americans battling cancer hangs in the balance.

Sincerely,

Patrick Cobb, MD
President

CMS Announces Severe Cuts to Medicare Funding for Cancer Care

The Centers for Medicare & Medicaid Services (CMS) has issued a proposed rule for the 2010 Medicare Physician Fee Schedule. Among other provisions are cuts to imaging services, elimination of the consultation payment codes, attempts to reinstate the Competitive Acquisition Program (CAP) for Part B drugs, and the 21.5% cut in payments to all physicians scheduled for 1/1/10 unless Congress acts to overturn this.

However, most significant, but not surprising, is an additional 6% cut in Medicare payments to community oncology practices effective 1/1/10. This is because CMS has used the data provided to the agency by the American Medical Association (AMA) in its Physician Practice Information Survey. Based on the data provided by the AMA to CMS, it shows that practice expense for community oncology has actually decreased by 8.3%. 



Community oncologists, mid-level providers, nurses, practice administrators, accountants, and policy experts reviewed the AMA survey last year and concluded that it was fundamentally flawed for community oncology. In a formal letter from COA to the AMA last year, Dr. Harry M. Barnes objected to the survey and summarized the reasons why it would not accurately capture oncology practice expense. The problem is not that CMS is basing these cuts on only 50 usable AMA surveys provided by medical oncologists. The real problem is that the AMA survey is fundamentally flawed and incapable of capturing the complexity of cancer care delivery. This is why COA so strongly objected to the AMA survey and launched the Components of Care Survey, which was designed by community oncology to accurately capture the clinical and operational components of delivering cancer care.



If community oncology practices do not act now they will experience a 6% cut in Medicare payments. Additionally, depending on how Congress addresses the scheduled 21.5% cut in physician payments, community oncology practices could be looking at additional payment cuts. Given that many in Congress want to create a public plan based on Medicare rates in order to force private insurers to lower rates, this is a true crisis point for community oncology.



COA will be meeting with CMS and the congressional leadership to protest these significant cuts. However, as we have repeatedly said, community oncology will continue to experience cuts until it has its own data to explain and document exactly what is required in delivering cancer care. COA is fighting harder than ever for community oncology. And those practices coming to DC on July 8th to Stand Up for Cancer Care will be sharing this new information with Members of Congress.



What should you be doing to deal with this crisis?



First, complete the Components of Care Survey IMMEDIATELY. Details can be found on the COA website at http://www.communityoncology.org. If community oncology does not have data to refute flawed AMA data, these cuts and others will continue.



Second, reach out to your Representatives to ask them to co-sponsor H.R. 2872, which is the National Quality Cancer Care Demonstration Project. This is the only national demonstration project that is focused on quality cancer care and open to all community oncology practices nationwide. It provides $300 million in additional funding for appropriate payment for services provided. 



Third, reach out to your Representatives and Senators to ask them to co-sponsor H.R. 1392 and S. 1221, identical bills that correct the prompt pay problem that artificially reduces any drug reimbursement based on Average Sales Price (ASP).

There is information on all these bills to share with your Members of Congress on the COA website (http://www.communityoncology.org).



COA will be providing additional information and details on all of this and more. It is critical that community oncology be fully engaged during these very challenging times when the cancer care delivery system is threatened by major healthcare reform and relentless cost cutting.

COA President Dr. Patrick Cobb Responds to President Obama's Address to the AMA

Community Oncology Alliance (COA) president Dr. Patrick Cobb responds to President Obama’s speech to the American Medical Association today on health care reform.

We agree with and applaud President Obama for stating the simple truth “that health care reform should be guided by a simple principle: fix what's broken and build on what works.”

Where we diverge respectfully with President Obama is to approach the healthcare solution as a simple fix, in part because of the misperception that “Five of the costliest illnesses and conditions - cancer, cardiovascular disease, diabetes, lung disease, and strokes - can be prevented.”

Cancer and the treatment of it must be separated out and understood implicitly by its inherent threat to life as well as the catastrophic impact of cost. We hope that the President and Congress will work together with community oncologists to address and fix what is broken. Therefore COA is advocating for the passage of multiple bills that will address the broken system as well as deliver Best Practices recommendations to improve the current model. And, in fact, oncologists already use evidence-based treatment guidelines in their daily practice.

Patients are stricken with cancer for many reasons, and not all cancer is preventable. And the longer we live, the more of us suffer from it. Concurrently, the older the patient, the more frequently the treatment is through Medicare.

Already, Medicare has cut reimbursement for cancer treatment to such a low level that it negatively impacts the quality of care provided to seniors. Models just completed by several large community cancer clinics show that if Medicare rates become the standard, clinics would have to close their doors.

Oncologists continue to struggle to stay in business under the current cancer reimbursement system, which is failing. Medicare does not sufficiently pay for the costs of chemotherapy and related drugs. As a result, oncologists are increasingly financing these patients or being forced to turn them away and even close their practices. This is at the core of the crisis in cancer care, and our government must understand that as the broken system is analyzed and fixed, cancer care must be a primary consideration.

As it is now, Medicare accounts for approximately 45% of all cancer care payments. We have to fix the broken Medicare system before even considering expanding it. We face dire consequences if we break what is working and do not address what is already broken.

Statement by Dr. Patrick Cobb, president of the Community Oncology Alliance, regarding declining rates of cancer death

“The Community Oncology Alliance is encouraged by the recently released statistics from the American Cancer Society showing a decline in the number of cancer deaths in the U.S. It is important to recognize that the decreasing cancer death rates are a result of several factors, including the quality and accessibility of cancer care provided by community oncology practices throughout the country.

Yet, we cannot ignore that in this year alone there will be almost 1.5 million new cancer cases and 560,000 cancer deaths.

The U.S. cancer care delivery system is now in the first stage of a crisis because Medicare has substantially cut payment for cancer drugs and essential services. Increasingly Americans with inadequate or no insurance, including seniors unable to pay the Medicare 20% coinsurance, are foregoing cancer treatment. We are entering a second stage crisis as we lose oncologists relative to the increasing incidence of cancer.

The Community Oncology Alliance has been actively working on solutions, starting with the Quality Cancer Care Demonstration project (QCCD), a substantive program developed by community oncologists over the past year to enhance the delivery of quality cancer care. The project will focus on patients covered by Medicare (approximately 45% of all cancer patients) and involves collecting data and implementing a patient-centric program to enhance cancer care while controlling costs. The QCCD project is a means of moving forward immediately with real healthcare reform, and provides the foundation for a solution to the crises in cancer care.

The Community Oncology Alliance is actively working with the Congress in integrating the Quality Cancer Care Demonstration project into healthcare reform legislation.”

Need for the Components of Care Survey

The Senate Finance Committee has proposed policy options that would severely cut Medicare payments for cancer care services. As CMS looks to recalculate payments for all medical services from Medicare, it too will be relying on a published report of a different kind; the AMA Practice Expense Survey Data obtained from a random sampling of physicians, both academic and community based. And, although the AMA survey may be appropriate to capture practice expense for primary care, it was not designed for the variety and complexity of services delivered by community oncology practices. Without our own data on the clinical and operational components of delivering cancer care, community oncology simply has no way of defending itself against cuts proposed by Congress and/or the Centers for Medicare & Medicaid Services (CMS).

Many of you will recall the damages incurred in 2002/2003, when CMS was provided with simplistic and outdated data on community oncology practice expense. CMS has continued to rely on that outdated and grossly inaccurate data as the rationale for not creating additional payment codes for the essential services in oncology, as was the congressional intent in the the Medicare Modernization Act of 2003 (MMA). A statement from another professional organization representing physicians who treat people with cancer helps to drive home the importance of completing COA’s Components of Care Survey and it reads: “If oncologists submit too little data to be considered valid, we may jeopardize our field relative to others who did provide sufficient data. The risk of not participating is that oncology payments will be static or reduced, while others move ahead at our expense.” 
 


The question you need to answer is, “Do you want outdated and non-specific data to be used to further cut Medicare payments for the services you provide?” If the answer is “No,” you need to return the Components of Care Survey ASAP. If you do not have a copy of the survey, go to the Community Oncology Alliance (COA) website above to access the survey and instructions. There is also contact information if you have any questions on how to fill out the survey.



The Components of Care Survey was designed by a team of representatives from community oncology practices and beta tested before it was fielded. It takes some time to fill out because it captures the complexity of what you do to deliver cancer care. If it were easy to fill out, like past surveys, it would not capture the clinical and operational complexity of cancer care.



In addition to helping your practice by contributing your data to community oncology, you will be provided with new information that will help you in your negotiations with private payers. Only practices returning the Components of Care Survey will receive specific data to help in negotiations with private payers and access to a network of administrators sharing information on how to optimally use the data in negotiations.